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Intraoperative Bypass-Flow-Measurement Reduces the Incidence of Postoperative Ventricular Fibrillation and Myocardial lnfarction after Coronary Artery Revascularisation
Autor: | Bauer, SF; Bauer, K; Rosendahl, UP; Dalladaku, F; Ennker, IC; Ennker, J |
Erscheinungsort: | Thorac Cardiovasc Surg 2002; 50 Suppl. 1: S27-S29
© Georg Thieme Verlag Stuttgart - New York. ISSN 0946-477 |
Inhalt: | Dept. of Cardiovascular and Throacic Surgery at the Heart Center Lahr/Baden, Lahr, Germany
Objective: Sudden ventricular fibrillation (VF) and myocardial infarction (M1) are a life-threatening complications after coronary artery bypass grafting (CABG).We analyzed prospectively the impact of intraoperative bypass-flow-measurement with the transit-time-doppler-fiow-method (TTDF) on the incidence and outcome of postoperative VF and MI.
Methods: In 1995 a standardized algorithm for the treatment of postoperative VF was introduced in our institution. The rate of postoperative VF was therefore exactly registrated. In 1998 the TTFD-method was implemented as a standard in all CABG-cases. Whenever a insufficient bypass-graft-flow was detected the anastomosis was redone and technical problems concerning the grafts were excluded. The incidence of postoperative VF and MI was now observed prospectivly and the new data (8/01) was compared to the data from 1995 to 1998.
Results: From 1/95 to 7/98 a total of 4321 patients (groupA) were operated on with isolated CABG-procedures using extracorporal circulation. In the time course from 8/98 to 8/01 a total of 3421 patients (groupB) was operated on with isolated CABG-procedures under the same conditions, except that the TTFD-method was used in every case. The treatment of VF was standardized in both groups according to the algorithm. The rate of insufficient bypass-flow detected by angiography was reduced by 66%. The incidence of postoperative MI significantly decreased from 3.5% (151) in group A to 1.8% (62) in group B. |
| Group | n | Incidence of VF | Mortality of VF | Total mortality |
|---|
A | 4321 | 34 (0,77 %) | 4 (28,6 %) | 44 (1,01 %) | | 3421 | 12 (0,35 %) | 1 (9,4 %) | 30 (0,87 %) |
| |
| Conclusion: Consequent use of TTFD significantly reduced the incidence of postoperative VF, postoperative MI and angiographically detected bypass-malfunction. A simultanously implemented algorithm reduced the mortality after CABG. The use of TTFD is an easy to use, non-invasive tool for quality assurance in CABG and therefore strongly recommendable. | |
